Funding awarded for motivational interviewing pilot trial to reduce foot ulcer rates in areas of deprivation

A three-year trial will deliver motivational interviewing to people living in areas of deprivation in a drive to change behaviours and prevent diabetes-related foot ulcers.

Glasgow Caledonian University researchers have been awarded funding of almost £300,000 for the trial, which involves talking to people about the barriers they face to making positive lifestyle changes.

Motivational interviewing has proved to be successful in other treatment areas, including addiction and weight loss.

The research team hope that by empowering people to adopt and maintain new lifestyle behaviours, it will reduce rates of ulceration, amputation and death in those with diabetes.

It follows the team’s research in the Greater Glasgow and Clyde health board area which revealed that people with diabetes who live in areas of deprivation were four to five times more likely to develop a foot ulcer, undergo amputation or die, compared to those living in wealthier areas.

The trial, Motivational Interviewing For The Prevention Of Diabetes-Related Foot Ulceration In People Exposed To Multiple Deprivation: A Pilot Trial, is being led by Dr Ruth Barn, Dr Gordon Hendry and Dr Jodi Binning following the funding award from the Scottish Government’s Chief Scientist Office.

Dr Barn said: “Current treatment approaches are not effective. People with diabetes are well informed about their condition but this does not necessarily lead to behaviour change.

“We have developed a new treatment based on motivational interviewing − a way of having a conversation with a person that helps them understand their reasons and barriers to positive lifestyle change, and supports adoption of new behaviours, or stopping unhelpful behaviours, to prevent foot ulcers. This approach has previously been successful for people attending services in other areas such as addictions, long-term condition management and weight loss.

“Our aim is to undertake a small trial, comparing motivational interviewing to current care, to find out if a larger trial is possible and worth doing. We hope that this intervention could empower people with diabetes and foot ulceration, leading to improved self-care, and reduced ulceration and amputation rates, in the long run.”

The trial will see podiatrists trained in delivering motivational interviewing, particularly for people with diabetes who face the greatest risk of complications.

Dr Hendry said: “While motivational interviewing intervention is focused on behaviour change, the actual outcome we are interested in reducing is the number of ulcers that people develop during that follow up period. As little as a 10% reduction in ulceration rate could bring significant cost-benefits to the NHS and would be enough to justify a much larger future trial.

“It’s possible that a little bit of behaviour change chosen and driven by patients themselves, with the support of highly trained podiatrists, will have a tangible effect on reducing ulceration and amputation rates in a group that has greater need.”

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